RT Journal Article
SR Electronic
T1 Endosaccular treatment of 113 cavernous carotid artery aneurysms
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 359
OP 362
DO 10.1136/jnis.2010.003137
VO 2
IS 4
A1 Choulakian, Armen
A1 Drazin, Doniel
A1 Alexander, Michael J
YR 2010
UL http://jnis.bmj.com/content/2/4/359.abstract
AB Objective Cavernous carotid aneurysms (CCAs) can present with visual symptoms or with subarachnoid hemorrhage (SAH). As surgical treatment of these aneurysms can be technically challenging, endovascular management has emerged as the preferred treatment modality.Methods A retrospective review was conducted of 113 patients who underwent endosaccular treatment for CCAs. Presenting symptoms, aneurysm size, use of stent assistance, rate of thromboembolic complications, presence of SAH and angiographic follow-up were reviewed.Results 29 patients (26%) with CCAs presented with diplopia due to cranial nerve palsies. Mean aneurysm size in this group was 17 mm. Three patients (2.6%) presented with SAH with a mean aneurysm size of 15.3 mm. Mean length of stay for ruptured versus non-ruptured aneurysms was 11.7 and 1.7 days, respectively. Clinically significant thromboembolic complications occurred in four cases (3.5%). Stent assistance was required in 53 cases (47%). Of the 86 patients (76%) returning for follow-up angiography (mean 6.2 months), 58 (75%) had no residual aneurysm and 14 (12%) showed regrowth. Thirteen patients (11.5%) underwent repeat endovascular treatment.Conclusions CCAs commonly produce diplopia and cranial nerve palsies when a critical size is reached (mean 17 mm in our series). Aneurysm obliteration with internal carotid artery preservation is the preferred treatment modality and can be accomplished with coil embolization with or without stent assistance. Although recurrence and retreatment can occur, the thromboembolic risk of endovascular treatment is low. Consideration should be given to treatment of asymptomatic CCAs 15 mm or larger due to potential risks of cranial neuropathy and SAH.